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Cold, sweaty and nauseous, Stefan R. burst into the pale-green bathroom stall of the movie theater men's room to spend his first experience with OxyContin face down in a public toilet. The sickly green paint of the stall, he says, seemed appropriate given the state he found himself in after taking 80 milligrams of one of the world's strongest pharmaceuticals. The only problem was, he liked it.

"I loved it, actually," says the stocky, bespectacled 25-year-old over a cup of black coffee. "My pupils were the size of pinpricks, and I was covered in sweat and couldn't stop throwing up, but it felt good. I felt good."

Typically prescribed for people in chronic and excruciating pain—cancer patients, the terminally ill—OxyContin (that's "Oxy" for oxycodone, a common narcotic painkiller, and "Contin" for continual, as in a continual steady dosage) is one of the most frequently prescribed brand-name painkillers in the country, with 1.4 million prescriptions written in 2006.

The pills contain a huge amount of active narcotic but are coated in a time-release shell that spreads that dosage over about 12 hours. What Stefan, who asked that his last name not be used, had learned about OxyContin 15 minutes before sprinting into the bathroom stall was the same thing millions of others have learned: remove the outer shell, and you've got something akin to pure, lab-grade heroin.

"I think heroin is the most insidious drug out there, and a lot of kids aren't ready to cross that line," Stefan says. "Pills, though—you can get those anywhere. Everyone takes pills, so kids are more inclined to experiment with those."

That day in the cinema's bathroom was eight years ago. What followed for Stefan was a six-year addiction, first to pills, then to street heroin, methamphetamines and crack cocaine. It didn't take long for his life to spiral out of control. Selling drugs, burglarizing homes and businesses, stealing from friends and family and shoplifting to support his $800-per-week habit, Stefan bottomed out in 2007 with an extended stay in jail, his second incarceration in as many weeks and his third overall.

"I just went out and hustled every day to try and get enough cash to get pills and, later, heroin," he says. "It was disgusting."

Bitter Pill
After years of complaints lodged against Purdue Pharma, the makers of OxyContin, and hundreds of deaths linked to drugs of its kind, the U.S. Food and Drug Administration is now taking the unprecedented step of issuing safety guidelines for an entire class of drug. Last February, the FDA wrote letters to 16 producers of extended-release opiate medications, including Purdue, asking them to come up with plans to curb abuse of the drugs. On Dec. 4, those same drug makers met with FDA officials in Baltimore for an update on their efforts. Officials now say they hope concrete guidelines for extended release opiates like OxyContin, including abuse-resistant capsules and educational campaigns, will be in place by spring 2010.

Though the FDA is just now taking steps to address OxyContin's potential for abuse, problems surrounding the drug have existed for more than a decade. Dubbed "Hillbilly Heroin" shortly after its release in 1996, the drug became popular in places like West Virginia and Kentucky, where users stole or traded the pills from disabled friends and family members and used them for a quick high. It wasn't long, however, before abuse of the drug moved out of the backwaters and into the mainstream, saturating the streets of East Coast cities and eventually moving west.

"I remember hearing about it being in New York and places like that, then suddenly it was everywhere around here," Stefan recalls. "Of course I was curious. I wanted to get my hands on some."

At the time, Purdue had mounted a massive and, it was later proven, misleading advertising campaign aimed at doctors that claimed OxyContin had little potential for abuse and was far less dangerous than other narcotic painkillers. In 2007, after a federal investigation, Purdue executives pleaded guilty to felony charges of deceptive marketing and the company paid $634.5 million in damages for what the U.S. Justice Department described as "one of our nation's greatest prescription drug failures."

The case ended not long after a federal survey found that 5.2 million Americans reported using prescription pain drugs like OxyContin inappropriately. High-profile cases like conservative radio host Rush Limbaugh's admitted addiction to OxyContin in 2003 and the deaths of actor Heath Ledger in 2008 and Adam Goldstein (aka DJ AD) this year, both of which involved OxyContin, have led to a public outcry for more regulations.

"This is our attempt to try and ensure that the benefits of the products outweigh their risks," said John Jenkins, director of the FDA's Office of New Drugs, during a press conference after the Baltimore meeting last month. "By their design, these drugs have a large amount of opioids, and if used incorrectly—like OxyContin, where crushing the tablets and chewing them can lead to the release of all the opioids—it can lead to serious safety concerns."

Slippery Slope
California is experiencing a fast rise in heroinaddiction. Opiate-related deaths have shot up 30 percent since last year, as cheap, low-grade heroin has flooded the streets through drug-dealing gangs like the Sureños. Like Stefan, dozens of current and recovering addicts interviewed for this story say that their opiate addictions began with pills like Vicodin (which combines an opiate called hydrocodone with acetaminophen), Percocet (oxycodone and acetaminophen) and OxyContin before moving to street heroin. Stefan puts the number at roughly two-thirds. "I'd say about 70 percent of the people I met in treatment for heroin started out on pills like Oxy," he says.

Current estimates of OxyContin-related deaths range from several hundred to several thousand, and have not been published officially since 2002, when the U.S. Drug Enforcement Agency completed a study that found 146 deaths "directly" caused by OxyContin and 318 more that were "likely" caused by the drug. Just last month, however, the Canadian Medical Association Journal published a study which showed that oxycodone-related deaths have risen 500 percent in the province of Ontario since 2000, when OxyContin was introduced to the country's public health system.

Breaking the Habit
Stefan didn't get clean on his own. He had help from counselors, friends and, most importantly, he says, from his mother, Judith. A self-admitted "enabler" during the early stages of her son's addiction, Judith says the hardest and most pivotal moment in helping her son was the day she kicked him out of her house.

"In ways, I was always trying to fix it. I was the mom, I put his Band-Aids on when he fell, and I thought I could fix his addiction too," she says. "I had to break myself of that habit and learn to say no."

Judith, who asked that her last name not be used, found help for her own sake through the treatment group Nar-Anon, which focuses on helping nonaddicts deal with the addiction of a loved one. Other addicts look to get help at methadone clinics, where a steady supply of drugs are given to an addict before eventually being tapered off.

Others, however, take a more holistic approach, and Dr. Richard Gracer of Gracer Medical Group is leading a new wave of addiction treatment that combines natural detox methods with advanced, synthetic opiate medications like Buprenorphine, which blocks the effects of opiates. He blames the FDA for not working fast enough to regulate dangerous opiates like OxyContin and says pain pills are often the earliest building blocks of addiction.

"Oxycodone is often a starter drug, and it's very dangerous," Gracer says. "People get started usually by getting prescribed the drug for back pain, or sometimes they have had operations, or they're kids who raid Mom's medicine cabinet. Pretty soon they have to take more and more to even feel normal. By the time we see them, their life is on hold, they've been through rehab a couple times, they've stolen from their parents, they've had enough."

Stefan, who's now finishing his junior college exams and plans to go on to study psychopharmacology at UC Berkeley, is one of the lucky ones. He spends his days going to 12-step meetings and sharing his story with anyone who will listen.

"Of all the people I knew personally that did Oxy, every one of them is now on heroin," he says, stubbing out a Camel Wide on the sidewalk. "For me, I was just a normal guy. I came from a loving, supportive family, but I still got caught up in it.

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The flip side to this story is the people who legitamatley need this medication to function relatively normal. I know people who have had back operations and herniated disks ect, and they have a lagitamate need for this medication and the fda and goverment getting involved will make it harder for people who should be on the meds to get them .First doctors will be afraid to per5scribe the meds for fear of lossing their licence or other goverment harrasment.I don't know the answerbut it's not for the goverment to decide medical rules look how they handle the country. God help the people who need this med

bgc5150: yeah, but even then addiction results. Someone really close to me has very severe back pain, has for years. He has two bad discs in his back and was prescribed opiate pain pills for it for years - even straight morphine pills. Well, over time they stopped doing the trick and he had to take more and more ..eventually he got to the point where he would get the pills off the street, and he found that he was using it more for depression than actual physical pain.

At the high-point of his addiction, he was unable to move off of the couch if he didn't have the pills, and the last time when he ran out - unable to face the mental anguish of even just getting up to go to work without his meds - he finally tried to commit suicide. He slit his wrists - not once or twice, but maybe even as much as seven times or more - gouging deeper in each time. I found him about 20 minutes later and called 911 - if I wouldn't have been awake he would have bled to death. He told me he wanted to die - it was the only way he felt that he could escape from the pain and mental anguish at that time. But I couldn't let that happen.

After going to the hospital and mental ward for a good number of days, he has given up the pills but is still going through depression and, without a doubt, physical pain which I am sure is 100x worse now that his natural opioid system is so out-of-balance. He's on an antidepressant which is only helping a little, and is resulting in a lot of side-effects.

I wouldn't recommend these pills to people with chronic pain, either, because after awhile they simply get the user caught in the same vicious cycle that one would get caught up in with heroin..I've seen it first-hand and I'm still going through it with a loved-one. It's far from over for him and me.

Personally I think that everybody who gets prescribed these devil-pills for chronic pain and develops an addiction should be able to sue Purdue for the damages to their life.

The costs that he will have to cover from the lost work-time, the hospital bills, the counseling, antidepressants, doctors, hand-therapy...the list goes on and on. Even the $25 surcharge he has to pay every time he sees a doctor is adding up mighty quickly. Not to mention all the money he could've had towards a place to live in his old-age, that he blew on these drugs! This is real - I quit all drugs and am currently looking for work right now in order to just help cover rent for these next few months - otherwise we are going to be on the streets. I'm scared, he's scared and we don't know what we're going to do. And even though he swore off the pills forever - such is the nature of addiction that I would not put it past him to use again ..getting them off the streets or the like.

It isn't right for these pharmaceutical companies to hand out legal heroin as if it were candy for those with pain, and expect things to turn out alright. It isn't alright, and these pills merely mask the pain and the problems until they don't anymore, at which point they have manifested to a point where the user can't control it. His story is really fucked up, but the truth is it happens every day to thousands of people. For chronic pain, there is no way to use these responsibly - just because of the way that opiates are! These pharmaceutical companies are merely drug dealers posing as legitimate companies, and for them it's amazingly big-business.

GreenPort is spot on with his claim that even prescribed users can develop addictions. My mother is an ovarian cancer patient as has had everything from vicodin to oxys to fentanyl. After being on these medications for an extended period of time she developed a high tolerance to the drugs. Her normal prescriptions wouldn't last her very long and she would soon have to rely on paying outrageous sums of money to get the medication that she so desperately needed. Fortunately she has since broken this viscious cycle and uses them sparingly when absolutely nescessary.

People intentionally abusing these drugs and becoming addicted is one thing but a woman following doctors orders and having the same outcome is just wrong.

In Swim's general area oxy has been substituted with morph or oxycodone. Oxy's were not that hard to come across but a friend told swim they cut their mom off. This was because they are trying to fray doctors away from this pill and replace it.

Another friend of swim has had a couple of heart surgeries and they give dillies over oc's.

Plus discontinuation of the high oxycotnin's(swim thinks like the 160mg's) got discontinued was a sign when replaced by 200mg morphs. It does not make much sense but this drug has gotten popularized and caught they eye of the much LE

The reason this swimmer believes there is a rise in oxy use is because it appears to be more of a "party drugs." Swim doesnt know about you, but when Swim sniffs some morphineswim is more inclined to be alone and just relax. However, when swim is sniffing some oxy, same has energy and relaxation, its perfect for shy people. "Of all the people I knew personally that did Oxy, every one of them is now on heroin," he says. This is both hard for me to believe and understandable. Heroin didnt give this swimmer a similar enough "high" for this swimmer to keep wanting to use. Then again swim didn't have a come down after 3 months of daily use of oxy. Literally nothing outside of just being bored the next day. Very strange swim knows.

As a pain patient, SWIM can honestly say that what greenport said is accurate. These drugs are very tricky to handle. Anything that has a pleasurable side-effect is hard to handle. Opioid therapy should really be used as a last alternative rather than a "front line" treatment. SWIM has made zero progress since day one of opioid treatment. His dose escalates, therefore he is forced to take lesser amounts that do not provide relief, just to keep tolerance at a reasonable level. It is a constant fight with tolerance. He could go up and up in dosage. All opioid therapy does is brings pain to a somewhat managable level, but only for a matter of months, then more is needed, until it comes to a point when the doctor simply cannot prescribe anymore. But sadly, until our medicinal technology improves, millions of people have no choice. Its really a tough thing.

On the note of "abuse proof" opioid meds, that is a very long ways away. Even though SWIM thinks opioid therapy should be used as a near last solution, it should be available to everybody who needs it.

whoever wrote this has no idea what there talking about dispite thier second hand experience with someone else. If uyou have not or do not live in severe chronic pain it is not in your arena to say what is or isn't to be done. There are only so many things one can do in this case. It's up to the individual whether they chose to abuse a drug and overuse it to get high. It is the people who run around and think its all cool to have a pill habit that causes people who need opiats to not be able to get them when needed.